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Sub-conjunctival haemorrhage

A sub-conjunctival haemorrhage is caused by a bleeding blood vessel under the conjunctiva. Patients will often present after being told they have a red eye and may not have noticed any symptoms. They usually have no cause but are more common after coughing or vomiting excessively. Can also be caused by mild trauma.

Symptoms

Patients may describe a mild popping sensation in the eye prior to observing the redness

May describe a mild FB sensation or an eye ache

Usually symptom free

Ask/review use of any NSAIDs or anticoagulants

Any history of coughing, straining, trauma or vomiting

Signs

A flat, bright red haemorrhage in the conjunctiva

Eye examination

Check blood pressure

Observe lids and conjunctiva with white light

Instil 1 drop of proxymetacaine 0.5% with fluorescein 0.25%

Observe for corneal staining preferably using a blue light

Treatment

Give patient sub-conjunctival haemorrhage information leaflet

If no history of trauma, no treatment is required. Reassure patient that the haemorrhage will resolve over the course of about a week or two

If trauma is the cause, consider referral to an ophthalmologist to ensure no underlying scleral damage or other injury

If subconjunctival haemorrhages are recurrent further investigations may be required to exclude any clotting disorders; however in most cases no underlying serious cause will be found